Mothers and babies

They may sleep in drainage ditches, alleys or motel rooms. The cold of winter, blistering Texas heat and even hunger don’t matter.

“All I cared about was getting my next fix,” said Diana Garcia, one mother who has recovered from opioid use disorder at Casa Mia with her now 3-year-old daughter, Eliana.

The recovery home is one of only a few in Texas that gives mothers with substance use disorder the opportunity to recover with their children.

Casa Mia, which opened in November 2018, provides the supervision, structure, support and hope mothers with substance use disorder need to turn their lives around.

Ordinarily, when pregnant women or mothers with children are using substances, Child Protective Services will seek safe living arrangements for children. If arrangements can’t be found with family or friends, they likely will enter the foster care system.

“Many of these mothers have experienced significant personal trauma. While placing their children in foster care may initially provide safety, it prevents mothers and babies from bonding and adds to a continuing cycle of trauma that can impact future generations,” said Lisa Cleveland, PhD, APRN, FAAN, professor of nursing.

How Casa Mia works

Cleveland founded Casa Mia with Kevin Downey, PhD, who serves as CEO of Crosspoint Inc. It has offered behavioral health care, recovery support and transitional residential services for more than 50 years.

The School of Nursing and Crosspoint provide safe, supervised group living arrangements for pregnant and parenting mothers and their children at Casa Mia, located in a comfortable, two-story, brick home in San Antonio’s Monte Vista neighborhood. The home’s capacity is 20 women and children. Crosspoint’s staff supervises life at the house and provides recovery-focused case management while the women attend treatment programs offered by community partners and work toward sustained recovery.

The mothers are encouraged to visit their babies in the hospital, where the newborns may stay for weeks if they experience neonatal abstinence syndrome or withdrawal symptoms. The symptoms may include inconsolable crying, seizures, weight loss, difficulty eating, vomiting and diarrhea.

The mothers learn to practice kangaroo care, a comforting technique in which they hold their babies against their bare chest. In earlier research, Cleveland found that this practice can reduce neonatal abstinence syndrome symptoms, support on-demand breastfeeding and promote mother-baby bonding.

Mothers also can reunite with older children through increased visitations, leading to overnight stays at Casa Mia. Some preschool children eventually move in full time.

Casa Mia partners closely with local programs that offer a community approach to helping mothers recover from substance use disorder by attending a 13-week series of parenting and life skills classes. One of those programs, which Cleveland helped disseminate statewide, is the Mommies Program that promotes the use of successful medication-assisted treatments, such as buprenorphine and methadone.

A mother’s progress is defined individually but is typically focused on establishing and maintaining recovery, securing a continuing source of income, obtaining stable housing, and regaining or maintaining custody of her children, Cleveland explained.

“One of our most successful mothers moved into Casa Mia in November 2018 and progressed so quickly that she was reunited with her 7-month-old son that Christmas,” Cleveland said.

That mother has thrived in her recovery, now living independently with her son, Cleveland added. She moved into her own apartment with her son and has completed the education needed to become a peer counselor in one of Crosspoint’s women’s recovery programs.

“Since it opened in 2018, Casa Mia has provided housing for 80 adult women and 51 children,” Cleveland said. “Ten of our residents have given birth while living at Casa Mia and at least 34 moms have regained custody of their children. Residents who graduate from Casa Mia are eligible to return if they encounter challenges in their recovery or housing status, and five women have done this so far.”

‘It’s like a family’

Garcia, who lived at Casa Mia with her newborn daughter for seven months, said that while she was pregnant, she worried she would lose custody of her child. When a caseworker with Child Protective Services told her about Casa Mia, she saw it as a chance to change. Keeping her baby became her goal, and Casa Mia played a big part in stabilizing the young family.

“Living here is not easy,” Garcia said at the time. “There are a lot of restrictions. A lot of times I didn’t want to do this anymore. But since being here I haven’t had cravings [for drugs]. I have Eliana. I cannot imagine a day without her. We all have chores, and we all help each other with advice and child care. It’s like a family.”

When Garcia began working, Eliana went to the child development center at the Healy-Murphy Center. Working in partnership, the center and the School of Nursing provide a variety of services for their clients. While the center provides child care for Casa Mia residents, the School of Nursing provides nutrition and health education for pregnant and parenting teens who attend high school or take GED classes at Healy-Murphy. The School of Nursing also runs a pediatric clinic for teen parents and their children.

With Casa Mia’s capacity holding at more than 80%, Cleveland knew she needed a bigger place. She received $3.8 million in fall 2020 from Texas Health and Human Services to move Casa Mia to a new women’s wellness campus being built by Crosspoint on the city’s East Side at 1500 Semlinger Road. The new facility, expected to open in 2024, will double Casa Mia’s capacity.

“There is a similar women’s campus in Houston for mothers and babies to recover together, but ours will be the first in the state to offer an on-site [neonatal abstinence syndrome] nursery and primary care clinic designed and operated by our School of Nursing,” Cleveland said.

Educating nursing students

Casa Mia has positively impacted nursing students such as Neal Hungerford, who has since graduated. His work-study assignment was to support the School of Nursing programs at Casa Mia.

“I wish that more nursing students could come here. This is a real eye-opening experience,” he said. “It makes you a better nurse. You’re definitely more compassionate.”

There also is a clinical rotation for nursing students led by Martha Martinez, MSN, RN. Nursing students, for example, have taught the mothers how to make sensory toys for their babies. Through the activity, the mothers learn what to expect regarding developmental milestones. In an effort to continually improve the program, the School of Nursing keeps statistics on the success of the program and conducts exit interviews with the moms as they move on to their new lives.

Expanding the model

In September, the School of Nursing received its Texas Department of State Health Services funding to work with national nonprofit partners to start similar programs in two other Texas cities.

“In Fort Worth, we are partnering with the WestCare Foundation and in Corpus Christi with Dimas Charities. Initially, the School of Nursing will be involved in helping them start their programs to ensure fidelity to the Casa Mia program model. Going forward, there may be potential for expansion of our role similar to the campus model here in San Antonio,” Cleveland said.

Guided by the voices of mothers

The inspiration for Casa Mia came from mothers who are involved with the Bexar County Neonatal Abstinence Syndrome Collective, a collaborative that Cleveland founded and chairs.

“It’s great to see their ideas become a reality and for this program to be so successful,” Cleveland said.

To learn more about Casa Mia, visit CasaMiaSanAntonio.com.